SHELLY WILLES OWEN (NPI# 1699064410) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699064410 |
| Entity Type | Individual |
| Full Name | SHELLY WILLES OWEN |
| Other Name | SHELLY R WILLES |
| Credential | PA-C |
| Practice Address |
111 S 5th St Douglas WY 82633-2434 |
| Practice Telephone | 3073587300 |
| Mailing Telephone | 3073587300 |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2016-12-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | TL519 | WY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
111 S 5TH ST |
| City | DOUGLAS |
| State | WY |
| Zip Code | 82633-2434 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689670267 | Phillip O Tigert | Physician Assistant | 111 S 5th St, Douglas, WY 82633-2434 | 2005-06-28 |
| 1972110138 | Melanie Hummert | Physical Therapist | 111 S 5th St, Douglas, WY 82633-2434 | 2020-09-30 |
| 1467070730 | Jordon Jacklin | Physical Therapist | 111 S 5th St, Douglas, WY 82633-2434 | 2020-07-13 |
| 1225662216 | Sara Marie Thronburg | Nurse Practitioner | 111 S 5th St, Douglas, WY 82633-2434 | 2020-02-27 |
| 1902447477 | Amanda Kay Dykes | Nurse Practitioner | 111 S 5th St, Douglas, WY 82633 | 2019-10-04 |
| 1043867872 | Aaron Bernal | Physical Therapist | 111 S 5th St, Douglas, WY 82633-2434 | 2019-08-26 |
| 1033765821 | Hannah Williams | Occupational Therapist | 111 S 5th St, Douglas, WY 82633-2434 | 2019-08-16 |
| 1710457601 | Michael Jeremey Littleton | Emergency Medical Technician, Paramedic | 111 S 5th St, Douglas, WY 82633-2434 | 2018-12-04 |
| 1275054751 | Shelby Hoskinson | Physical Therapist | 111 S 5th St, Douglas, WY 82633-2434 | 2017-07-05 |
| 1811447956 | Melissa Renee Bulkley | Nurse Practitioner | 111 S 5th St, Douglas, WY 82633-2434 | 2016-10-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710304399 | A Keeler Family Dental, LLC | Dentist | 1010 E Richards Street, Douglas, WY 82633 | 2014-03-21 |
| 1578836805 | Dawn Marie Marchak-cundy | Counselor | 1841 Madora Avenue, Douglas, WY 82633 | 2012-02-16 |
| 1982894739 | Tanisha Crystal Dexter | Pharmacist | 1202 East Richards Street, Douglas, WY 82633 | 2007-07-27 |
| 1669521324 | Stephan Paul Ediss | Chiropractor | 1330 E. Richards, Douglas, WY 82633 | 2007-01-10 |
| 1831280221 | Shauna R Kohler | Nurse Anesthetist, Certified Registered | 111 S 5th Street, Douglas, WY 82633 | 2006-09-28 |
| 1255438651 | County of Converse | Public Health or Welfare | 442 Center, Douglas, WY 82633 | 2006-09-20 |
| 1104834134 | Mark W Townsend | Dentist | 820 So 10th, Douglas, WY 82633 | 2006-08-04 |
| 1548206642 | Douglas Care Center, LLC | Skilled Nursing Facility | 1108 Birch, Douglas, WY 82633 | 2006-06-20 |
| 1023061223 | North Platte Physical Therapy Services Inc | Physical Therapist | Crook Co Memorial Serv Dist, Sundance, WY 82633 | 2006-05-18 |
| 1235611468 | Jessica Renee Snyder | Social Worker | 1841 Madora Ave, Douglas, WY 82633 | 2018-09-04 |
| Find all providers in zip 82633 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346864162 | Dayane Mota | Physician Assistant | 66 Sw Main St, Douglas, MA 01516-2503 | 2020-06-08 |
| 1396365524 | Emily Carroll | Physician Assistant | 20 Wixtead Ct, Douglas, MA 01516-2090 | 2020-04-17 |
| 1902202468 | Joel Hernandez | Physician Assistant | 110 Shirley Ave, Douglas, GA 31533-2324 | 2014-11-11 |
| 1831302868 | James Stephen Nobles | Physician Assistant | 1380 Gordon St W, Douglas, GA 31533-3432 | 2007-05-07 |
| 1689670267 | Phillip O Tigert | Physician Assistant | 111 S 5th St, Douglas, WY 82633-2434 | 2005-06-28 |
| 1598166175 | Dean M Harper | Physician Assistant | 100 Doctors Dr, Douglas, GA 31533-2210 | 2014-09-15 |
| 1952749137 | Rosa Crawford | Physician Assistant | 1101 Ocilla Rd, Douglas, GA 31533-2207 | 2013-06-10 |
| 1023353489 | Coffee Emergency Group LLC | Physician Assistant | 1101 Ocilla Rd, Douglas, GA 31533-2207 | 2012-12-11 |
| 1366724452 | Hallie S. Brigmond | Physician Assistant | 1101 Ocilla Rd, Douglas, GA 31533-2207 | 2011-09-14 |
| 1427343953 | Robert Snyder Rodriguez | Physician Assistant | 1100 F Ave, Douglas, AZ 85607-1919 | 2011-06-13 |
| Find all providers in DOUGLAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.